Benjamin Shield, Ph.D.
Effects of Obstetrical Interventions on the
Craniosacral System that Influence Breastfeeding
The Craniosacral System involves the structures from the head to the pelvis. This includes bones, sutures, fluids, membranes, and other soft tissue components. At birth, these structures are uniquely vulnerable.
When we imagine an adult’s head, we imagine a relatively firm structure. At birth, a baby’s head is primarily fluid and membrane. A baby’s head can be imagined as a sea of membranes with bones floating in that sea. Many bones, which are individual bones in adults, exist in babies as bones within bones. The sutures resulting from the bones in contact with one another do not form until the ages of two through four.
This presentation of the baby’s head allows for a systematic reduction in the overall size of the head during the birth process. It also provides for the rapid expansion of the brain during the early years. Where this presentation allows for the safety and growth of the child, it makes the baby more vulnerable to obstetrical interventions.
One obstetrical intervention that can result in various possible injuries is vacuum extraction (ventouse). As the cup is applied to the vertex of the baby’s head, the contents of the baby’s head are sucked into the cup. This includes bones, membranes, fluids, and delicate tissues. Pressure is then applied to pull the baby out by tractioning this tissue. This force is not a linear traction, but also involves a degree of torsion as well.
As the tissue is suctioned into the cup, the Aqueduct of Sylvius, the channel connecting the third and fourth ventricles, can become kinked. These ventricles are fluid-filled chambers involved in the circulation of the cerebral spinal fluid. Any restriction of this flow can result in a backpressure that can create increased intracranial pressure, which can result in hydrocephaly and multiple other pathologies.
The pulling and torsion can also result in the displacement of cranial bones, membranes, and cranial nerves, which can last a lifetime. It can also create a type of shock to the baby that interferes with the bonding process and the baby’s ability to breastfeed.
Any injury or impingement to cranial nerves V, VII, IX, X, XI, and XII can be detrimental to the baby’s ability to breastfeed. Cranial nerve V is involved with muscles of mastication (chewing) and is closely associated with suckling. Cranial nerve VII is involved with muscles of facial expression, which are also actively used in the suckling process. Cranial nerve IX innervates the throat muscles and involves the baby’s ability to swallow. Cranial nerve X is involved with the baby’s ability to swallow, as well as the entire gastrointestinal system. Cranial nerve XI involves the baby’s ability to orient its head. Injury to this nerve can restrict the baby’s ability to orient to the breast. Cranial nerve XII involves the baby’s ability to utilize its tongue while suckling.
Forceps can also injure these same cranial nerves. The medial, longitudinal, and torsional forces can compress the pathways of these nerves. Forceps can also potentially cause injury to the brain stem, where basic metabolic processes are monitored and controlled. Injury to the brain stem can have a significant effect on breastfeeding.
Both ventouse and forceps can create forces that overwhelm the baby and interfere with its ability to engage with the mother and with its environment. Often, the baby is left in a sympathetic state of fight or flight. More likely, the baby may be left in a state of parasympathetic shock and withdrawal, all of which would affect the baby’s ability to breastfeed.
Craniosacral therapy can help normalize the injuries caused by obstetrical interventions. Through gentle, purposeful, and respectful touch, it helps normalize the baby’s structure, remove impingements, and balance the effects on the autonomic nervous system. I feel that not every baby needs to be treated, but every baby should have the advantage of being evaluated.
William Sutherland, the founder of Cranial Osteopathy, had a favorite expression: “As the twig is bent, so grows the tree.” If we can help correct the injuries created by obstetrical interventions, we can not only assist the baby in optimal breastfeeding but also help prevent learning, structural, sensory, developmental, and behavioral problems later in life.